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Streptococcal Infections and Treatments · Journal article
Journal Français D Ophtalmologie · September 4, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a retrospective case series of 10 patients with preseptal necrotizing fasciitis caused by virulent Streptococcus pyogenes (group A Streptococcus), managed at a single centre between 2016 and 2024, with a notable epidemiological surge in 2022–2023. The authors describe their experience with conservative debridement and full-thickness skin grafting, reporting 100% infection control, but the series lacks a comparator group and does not present evidence that their approach is superior to alternatives.
Retrospective single-centre case series. All patients with preseptal necrotizing fasciitis diagnosed and managed at Rennes University Hospital between 2016 and 2024. Intervention: Conservative dermal debridement followed by full-thickness skin grafting; temporary tarsorrhaphy on postoperative day 15 in selected cases. n = 10. Rennes University Hospital, France.
Ten cases of preseptal necrotizing fasciitis identified between 2016 and 2024; one case recorded 2016–2021, nine cases managed 2022–2023 All cases caused by virulent Streptococcus pyogenes (group A Streptococcus) with emm genotypes emm1, emm1.3, and emm82 Mean patient age 41 years; most patients had few or no risk factors
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This series documents a recent epidemiological shift in preseptal necrotizing fasciitis, with all cases caused by virulent group A Streptococcus. Clinicians should maintain heightened suspicion for invasive streptococcal infection in preseptal fasciitis and consider empirical clindamycin, contact isolation, and prophylaxis for close contacts, though the superiority of the proposed debridement and grafting strategy relative to other approaches is not demonstrated.
A single-centre retrospective case series of 10 patients with no comparator group, describing clinical observations and management outcomes during a documented epidemiological shift, but lacking controlled evidence for superiority of proposed interventions.
As stated by the source record.
Quoted from the source exactly as published.
This series documents a recent epidemiological shift in preseptal necrotizing fasciitis, with all cases caused by virulent group A Streptococcus. Clinicians should maintain heightened suspicion for invasive streptococcal infection in preseptal fasciitis and consider empirical clindamycin, contact isolation, and prophylaxis for close contacts, though the superiority of the proposed debridement and grafting strategy relative to other approaches is not demonstrated.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
INTRODUCTION: We observed a marked increase in cases of preseptal necrotizing fasciitis over the course of a single year. While only one case had been recorded between 2016 and 2021, nine additional cases were managed between 2022 and 2023 at Rennes University Hospital. MATERIALS AND METHODS: We conducted a retrospective study including all cases of preseptal necrotizing fasciitis managed at our institution between 2016 and 2024. Clinical, microbiological, surgical, and outcomes data were analyzed. A review of the literature was also performed to propose an appropriate management strategy for these infections. RESULTS: Since 2016, ten cases were identified. All were caused by virulent strains of Streptococcus pyogenes (group A Streptococcus), with genotypes emm1, emm1.3, and emm82. The mean patient age was 41 years, and most patients had few or no risk factors. The marked increase in incidence observed in 2023 appears to correlate with the post-pandemic resurgence of invasive streptococcal infections. Fifty percent of patients initially treated with incision and drainage with packing required repeat surgery within 24hours due to clinical deterioration. Following dermal debridement, upper eyelid retraction threatening corneal integrity was observed by the end of the second week in all cases, necessitating management with full-thickness skin grafting. DISCUSSION: Recent epidemiological changes suggest that any case of preseptal necrotizing fasciitis should be considered a potential invasive group A Streptococcus infection. This warrants modifications in clinical practice, including empirical antibiotic therapy with clindamycin, patient contact isolation, case investigation, and antibiotic prophylaxis for close contacts. The conservative debridement technique described in this article achieved infection control in 100% of cases while limiting surgical morbidity. Healing by secondary intention may be considered in rare cases where the dermis is preserved. Reconstruction with full-thickness skin grafting combined with temporary tarsorrhaphy on postoperative day 15 appears to provide the best functional and aesthetic outcomes while minimizing corneal complications. CONCLUSION: This series highlights a recent shift in the epidemiology of preseptal necrotizing fasciitis, supporting the consideration of any new case as a potentially invasive and transmissible group A Streptococcus infection with significant public health implications. This situation calls for adaptation of clinical practices.
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